Jennifer Annette Lee, MT(ASCP)

Primary specialty

Medical TechnologistTaxonomy code 246QM0706X

License

MT-175524 Issued in SC

Practice address

190 Kimel Park Drive
VA Outpatient Clinic
Winston-Salem, NC 27103

Phone

(336) 768-3296

Fax

(336) 760-5481

NPI assigned

Oct 18, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Jennifer Grantham Proctor Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Department of Veterans Affairs

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1073863197
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164503561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 PARK AVE",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270282143",
            "telephone_number": "336-751-1659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 KIMEL PARK DRIVE",
            "address_2": "VA OUTPATIENT CLINIC",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-768-3296",
            "fax_number": "336-760-5481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JENNIFER",
        "middle_name": "ANNETTE",
        "name_prefix": "Mrs.",
        "credential": "MT(ASCP)",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246QM0706X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Pathology, Medical Technologist",
            "state": "SC",
            "license": "MT-175524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "PROCTOR",
            "middle_name": "GRANTHAM",
            "prefix": "MRS.",
            "credential": "MT(ASCP)",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David J Lee, OD
• Franklin Hyunsu Lee
• Heather Ann Lee, RPH, PHARMD
• Holly W. Lee, M.D.
• Hyung Won Lee
• Jessica Lee, D.C
• Jessica Heustess Lee, MA, CCC/SLP
• Joseph Alan Lee, PHYSICAL THERAPIST
• Karen Hall Lee, CRNA
• Katelyn Storey Lee, DMD

• Medical Technologist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Medical Technologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.